In a flipping of the proverbial script, a Senate Democrat facing a tough re-election race used a confirmation hearing of Sylvia Mathews Burwell, nominated to head the Department of Health and Human Services, to advocate forcefully in favor of Obamacare.

While Republican senators mostly went through the motions with their anti-Obamacare talking points or outright endorsed Burwell as Kathleen Sebelius's replacement, Sen. Kay Hagan (D-NC) used her time to trumpet the benefits of Medicaid expansion -- and emphasize the downside of not expanding.

Left unsaid, but strongly implied, was that her opponent, North Carolina House Speaker Thom Tillis, who locked up the GOP nomination earlier this week, had been instrumental in stopping the state from expanding Medicaid under the law.

"Last year in North Carolina, our state legislature and governor decided against expanding the state's Medicaid program," Hagan said as she started her questioning, "and as a result, about 500,000 people who would have qualified for coverage through Medicaid are not now able to do so."

"These are some of the most vulnerable in our society," she said, "who will continue to seek care in emergency rooms and then will leave chronic conditions unmanaged, which we know is detrimental to their health and the economy."

Hagan is one of the most vulnerable Senate Democrats, holding a slim 0.8 percent polling advantage over Tillis per Real Clear Politics. She has been one of the targets in the American for Prosperity's air campaign, which has attacked her for her support of the law.

"We've already seen a decrease in the number of uninsured" in Medicaid-expanding states, Burwell said after Hagan asked to compare the experiences of states that had expanded and states, like North Carolina, that had not.

Hagan then gave the example of a 35-year-old single woman whose income is below the federal poverty level -- therefore falling in the Medicaid expansion gap, which in non-expanding states means that those Americans will not have access to health coverage under Obamacare.

"So if a state had expanded it, she would have had access," Hagan said, "where in the 24 states that haven't expanded it, there is this huge number of people, in my state, 500,000, that are still without coverage."

Burwell said those people would not be subject to the law's individual mandate, but added: "It doesn't address the fundamental issue that you're talking about which is: Do they have health care coverage?"

Hagan completed her line of questioning by asking how much it would cost states to expand Medicaid in 2014, surely knowing that the federal government covers 100 percent of the costs through 2016.

"That would be zero," Burwell said. "The state doesn't pay."

In contrast to Hagan's aggressive pro-Obamacare performance, Republican senators were reserved. Almost none of the expected fire made an appearance. They hit the necessary talking points -- canceled health plans, the Medicare payment board characterized as "death panel" by the far right and the disastrous launch of HealthCare.gov -- but rarely pressed Burwell on her responses.

Sen. John McCain (R-AZ), who is not a member of the committee, actually introduced Burwell at the beginning of the hearing. A few Republican members, Sens. Johnny Isakson (GA) and Richard Burr (NC), didn't broach Obamacare at all in their questioning.

Burr, in fact, stated his strong endorsement of Burwell's nomination and quick confirmation as he left.

"I support her nomination and I will vote for it. She doesn't come with a single experience that would make her a good secretary. She comes with a portfolio of experience," he said. "I look forward to her confirmation being quick."